Provider Demographics
NPI:1689362915
Name:UPLIFT MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:UPLIFT MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:304-921-5324
Mailing Address - Street 1:5429 UNIVERSITY PKWY # 1083
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2012
Mailing Address - Country:US
Mailing Address - Phone:941-541-2297
Mailing Address - Fax:941-200-4539
Practice Address - Street 1:333 TAMIAMI TRAIL S SUITE 288
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-541-2297
Practice Address - Fax:941-200-4539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty